Spinal cord ischemia after aortic surgery

Abstract

This article discusses the etiology of spinal cord ischemia (SCI) mechanisms that may lead to paraplegia during open and endovascular repair from an anatomical and physiological perspective as well as the role of various protective measures used in prevention of this dreadful complication of aortic surgery. There are many adjuncts that must be considered to reduce the risk of spinal cord injury, such as revascularisation of intercostal arteries, maintenance of high mean blood pressure, spinal cord drainage and a few new promising models like NIRS and MISACE which usefulness is yet to be determined. These measures and techniques as well as possible etiology mechanisms of SCI are discussed, highlighting the evidence available for each method, the practical ways in which they may be used, giving some new theories and explanations.